Qin-Yuan Li, Lian Duan, E Wang, Cheng-Liang Zhang, Zhong-Hao Xiang, Feng Zhao, Tian-Yu Ouyang, Fan-Yan Luo, Yan-Ying Duan
{"title":"Hemoadsorption and Coagulation Systemic Rebalance in Patients Undergoing Nonelective Cardiac Surgery and Treated with Antithrombotics.","authors":"Qin-Yuan Li, Lian Duan, E Wang, Cheng-Liang Zhang, Zhong-Hao Xiang, Feng Zhao, Tian-Yu Ouyang, Fan-Yan Luo, Yan-Ying Duan","doi":"10.1159/000535807","DOIUrl":null,"url":null,"abstract":"<p><strong>Introduction: </strong>Insufficient withdrawal duration of antithrombotics leads to excessive bleeding after major surgery. We hypothesize that intraoperative hemoadsorption (HA) can reduce postoperative allogeneic transfusion requirements and excessive bleeding events (EBE), without an increase in ischemic/thromboembolic events (ITE) in patients who have taken antithrombotics and undergone nonelective cardiac surgery.</p><p><strong>Methods: </strong>A total of 460 patients admitted to our hospital from 2018 to 2022 were included in this study and divided into two groups: HA and non-HA. Because of the risk of bias due to differences in antithrombotic type, withdrawal duration, or basic coagulation function, propensity score matching was used for analyses.</p><p><strong>Results: </strong>Out of 154 cases in the HA group, 144 pairs were successfully matched. No HA safety events such as hemolysis, hypotension, or device failure occurred. After matching, the two groups were found to be comparable in preoperative antithrombotic type, withdrawal duration, platelets and coagulation function, and demographic and perioperative characteristics. Although the HA group did not have a reduced incidence of EBE, this group exhibited significant decreases in the transfusion rate and volume, the incidence of ITE, acute kidney injury, and central nervous system injury.</p><p><strong>Conclusions: </strong>For patients who have undergone nonelective cardiac surgery and taken antithrombotics, HA can simply and safely rebalance the postoperative coagulation system and have associations with reduced transfusion and postoperative ITE.</p>","PeriodicalId":8953,"journal":{"name":"Blood Purification","volume":null,"pages":null},"PeriodicalIF":2.2000,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11126205/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Blood Purification","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1159/000535807","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/1/9 0:00:00","PubModel":"Epub","JCR":"Q3","JCRName":"HEMATOLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Introduction: Insufficient withdrawal duration of antithrombotics leads to excessive bleeding after major surgery. We hypothesize that intraoperative hemoadsorption (HA) can reduce postoperative allogeneic transfusion requirements and excessive bleeding events (EBE), without an increase in ischemic/thromboembolic events (ITE) in patients who have taken antithrombotics and undergone nonelective cardiac surgery.
Methods: A total of 460 patients admitted to our hospital from 2018 to 2022 were included in this study and divided into two groups: HA and non-HA. Because of the risk of bias due to differences in antithrombotic type, withdrawal duration, or basic coagulation function, propensity score matching was used for analyses.
Results: Out of 154 cases in the HA group, 144 pairs were successfully matched. No HA safety events such as hemolysis, hypotension, or device failure occurred. After matching, the two groups were found to be comparable in preoperative antithrombotic type, withdrawal duration, platelets and coagulation function, and demographic and perioperative characteristics. Although the HA group did not have a reduced incidence of EBE, this group exhibited significant decreases in the transfusion rate and volume, the incidence of ITE, acute kidney injury, and central nervous system injury.
Conclusions: For patients who have undergone nonelective cardiac surgery and taken antithrombotics, HA can simply and safely rebalance the postoperative coagulation system and have associations with reduced transfusion and postoperative ITE.
导言:抗血栓药物停药时间不足会导致大手术后出血过多。我们假设,对于服用抗血栓药物并接受非选择性心脏手术的患者,术中血液吸附(HA)可以减少术后异体输血需求和过度出血事件(EBE),而不会增加缺血/血栓栓塞事件(ITE):本研究共纳入2018年至2022年我院收治的460例患者,并将其分为两组:HA组和非HA组。由于抗血栓类型、停药时间或基本凝血功能的差异存在偏倚风险,因此采用倾向评分匹配法进行分析:在 HA 组的 154 个病例中,有 144 对成功配对。没有发生溶血、低血压或装置故障等 HA 安全事件。配对后发现,两组患者在术前抗血栓类型、停药时间、血小板和凝血功能、人口统计学和围手术期特征方面具有可比性。虽然 HA 组的 EBE 发生率并没有降低,但该组的输血率和输血量、ITE 发生率、急性肾损伤和中枢神经系统损伤均显著下降:结论:对于接受非选择性心脏手术并服用抗血栓药物的患者,HA 可以简单安全地重新平衡术后凝血系统,减少输血和术后 ITE。
期刊介绍:
Practical information on hemodialysis, hemofiltration, peritoneal dialysis and apheresis is featured in this journal. Recognizing the critical importance of equipment and procedures, particular emphasis has been placed on reports, drawn from a wide range of fields, describing technical advances and improvements in methodology. Papers reflect the search for cost-effective solutions which increase not only patient survival but also patient comfort and disease improvement through prevention or correction of undesirable effects. Advances in vascular access and blood anticoagulation, problems associated with exposure of blood to foreign surfaces and acute-care nephrology, including continuous therapies, also receive attention. Nephrologists, internists, intensivists and hospital staff involved in dialysis, apheresis and immunoadsorption for acute and chronic solid organ failure will find this journal useful and informative. ''Blood Purification'' also serves as a platform for multidisciplinary experiences involving nephrologists, cardiologists and critical care physicians in order to expand the level of interaction between different disciplines and specialities.